During his time at San Francisco General, he helped develop effective models for HIV/AIDS clinical care for intravenous drug users, establishing three medical facilities located in methadone treatment centers.

In this position, he administered the newly-authorized Ryan White CARE Act, overseeing the distribution of federal funds and the planning of services in 25 AIDS epicenters, as well as in all 50 states and U.S. territories.

In 1994, Goosby became director of the Office of HIV/AIDS Policy in the United States Department of Health and Human Services, where he advised on the federal HIV/AIDS budget and worked with Congress on all AIDS-related issues.

[citation needed] In 1997, Goosby also served as interim director of the Office of National AIDS Policy at the White House, reporting directly to the President as his senior advisor on HIV-related issues.

[10] While with Pangaea, Goosby played a key role in the development and/or implementation of HIV/AIDS national treatment scale-up plans in Rwanda, South Africa, China, and Ukraine.

At the time of his swearing in, Goosby stated that his top priorities included:[13] As of September 2023, PEPFAR supported antiretroviral treatment for nearly 20.5 million people worldwide.